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Pancreatic cancer occurs when changes (mutations) in the pancreas cells lead them to multiply out of control. A mass of tissue can result. Sometimes, this mass is benign (not cancerous). In pancreatic cancer, however, the mass is malignant (cancerous).

There are two types of tumors that grow in the pancreas: exocrine or neuroendocrine tumors. About 93% of all pancreatic tumors are exocrine tumors, and the most common kind of pancreatic cancer is called adenocarcinoma. Pancreatic adenocarcinoma is what people usually mean when they say they have pancreatic cancer. The most common type begins in the ducts of the pancreas and is called ductal adenocarcinoma.
The rest of the pancreatic tumors — about 7% of the total — are neuroendocrine tumors (NETs), also called pancreatic NETs (PNETs), an islet cell tumor or islet cell carcinoma. Some NETs produce excessive hormones. They may be called names based on the type of hormone the cell makes — for instance, insulinoma would be a tumor in a cell that makes insulin.

2014 Statistics

Risk factors for pancreatic cancer include the following
Smoking
Obesity
Personal history of diabetes or chronic pancreatitis
Family history of pancreatic cancer orpancreatitis
Certain hereditary conditions

Symptoms
Most patients present with pain (in the back) weight loss or jaundice
Tumors in the head of the pancreas are more likely to have jaundice,
Those that arose in the body or tail, more likely pain and weight loss.

Bile: yellowish fluid produced in the liver that aids in digestion of fat in the small intestine

Bile: passes through the common bile duct through the head of the pancreas on it's way to the duodenum

Bile duct carries the bilirubin through the head of the pancreas on it's way to the duodenum

Tumors in the head of the pancreas are more likely to have jaundice

Tumors in the head of the pancreas are more likely to have jaundice

Tumors in the body or tail are more likely to present with pain or weight loss

Symptoms of Pancreas Cancer
Asthenia (weakness) 86 percent
Weight loss 85 percent
Anorexia (no appetite)-83 percent
Abdominal pain - 79 percentEpigastric pain (stomach)-71 percent • Dark urine-59 percent
Jaundice 56 percent
Nausea 51 percentBack pain - 49 percent
Diarrhea- 44 percent
Vomiting-33 percent
Steatorrhea (fatty stools)- 25 percent
Thrombophlebitis - 3 percent

Signs of Pancreas Cancer
Jaundice (yellow) - 55 percent
Hepatomegaly (large liver) - 39 percent
Right upper quadrant mass - 15 percent
Cachexia (wasting) 13 percent
Courvoisier's sign (nontender but palpable distended gallbladder at the right costal margin) 13 percent
Epigastric mass (fell lump in stomach) - 9 percent
Ascites (abdominal fluid) - 5 percent

Pathology
Ductal adenocarcinoma accounts for about 85% of all neoplasms. And more than 95% of all pancreatic cancers arise from the exocrine (digestive enzymes) elements.Cancers that arise from the endocrine cells (neuroendocrine, islet cells) account for 5% or less

Part of pancreas

Cancer in the Head of the Pancreas

Location of Pancreas Cancer
60 to 70 percent of exocrine pancreatic cancers are localized to the head
20 to 25 percent are in the body/tail and the remainder involve the whole organ
H = Head
N = Neck
B = Body
T = TailUn Uncinate

Tests used to evaluate and stage pancreas cancer
Routine blood tests e.g. liver products like bilirubin
Elevated tumor markers (CA 19-9 or CEA)
MRI, CT scans, Ultrasound
Endoscopy including endoscopic ultrasound or ERCP
LaparoscopyBiopsy

CA 19-9
The reported sensitivity and specificity rates of CA 19-9 for pancreatic cancer range from 70 to 92, and 68 to 92 percent, respectively.The rates of unresectable disease among all patients with a CA 19-9 level ≥130 units/mL versus <130 units/mL were 26 and 11 percent, respectively. Among patients with tumors in the body/tail of the pancreas, more than one-third of those who had a CA 19-9 level ≥130 units/mL had unresectable disease.

Elevated CA 19-9
Cancer
Pancreas
Biliary Cancer (gallbladder, cholangiocarcinoma,ampullary)- Hepatocellular
Gastric, ovarian, colorectal (less often)
Lung, breast, uterus (rare)
Benign
Acute cholangitis
- Cirrhosis and other cholestatic diseases (gall stones)

Ultrasound
study of 900 patients who underwent ultrasound to work up painless jaundice, anorexia, or unexplained weight lossThe sensitivity for detection of all tumors in the pancreas was 89 percent Among the779 patients who were followed over time and established not to have developed a pancreatic tumor, nine had false-positive US findings (specificity 99 percent).

Mass in the pancreatic head and dilated common bile duct and pancreatic duct

CT
Sensitivity of CT for pancreatic cancer depends on technique and is highest (89 to 97 percent) with triple-phase, helical multidetector row CTAs expected, sensitivity is higher for larger tumors; in one study, the sensitivity was 100 percent for tumors >2 cm, but only 77 percent for tumors ≤2 cm in size

Endoscopy or ERCP or EUS

ERCP or Endoscopic retrograde cholangiopancreatography

ERCP

ERCPInject dye into the duct system and look for compression

ERCP
Sensitivity of 92 percent and Specificity of 96 percent for diagnosing cancer of the pancreas by ERCPERCP provides an opportunity to collect tissue samples(forceps biopsy, brush cytology) for histologic diagnosis.However, the sensitivity for detection of malignancy (approximately 50 to 60 percent) is lower than that of endoscopic ultrasound (EUS)-guided FNA (sensitivity 92 percent)

EUS or Endoscopic Ultrasound

Endoscopic Placement of a Stent

CT Scan - Pancreas Cancer

CT Scans

CT or PET Scan

PET Scans

Stage IA (T1aNOMO)

Stage IB (T2NOMO) over 2cm, limited to pancreas

Stage IIA (T3N0) beyond the pancreas

Stage IIB (T1-3N1M0)

Stage III (T4) Unresectable Cancer has spread to the major blood vessels near the pancreas. These include the superior mesenteric artery, celiac axis, common hepatic artery, and portal vein.